Surgical Results of Depressed Skull Fractures

Many advances have taken place in the management and treatment of head injured patients in recent years. Despite this, there have been few studies about depressed skull fractures as a subgroup of head injured patients. The aim of this study was to evaluate surgical results of patients with depressed skull fractures. This cross-sectional study was conducted on 74 patients (50 males and 24 females) with the mean age of 20 years (5- 52 years) who were admitted in neurosurgery department of Urmia Imam Khomeini hospital during 4 years (2009-2012) with depressed skull fracture and treated surgically. Preoperatively, CT scan was done in all patients. Prophylactic antibiotics and antiepileptics were administered in all cases. Variables such as: type and cause of fractures, neurologic deficit, seizure, postoperative meningitis, skin defect, wound infection, CSF leak and mortality were evaluated. Patients were followed up during one year after surgery. From 74 cases, 60(81%) were compound and 14(19%) cases were simple fractures. In 8(11%) patients fracture were crossed the midline (over superior sagittal sinus). The cause of depressed fractures were road traffic accident in 38(51%) cases, fall from height in 23(31%) cases, physical violence in 5(7%) cases, sports related injury in 2(3%) cases and miscellaneous in 6(8%) cases. Level of consciousness before surgery was ranged from 5 to 15 based on Glasgow Coma Scale. Postoperatively complete recovery occurred in 50(67.5%) cases, hemiparesis in 10(13.5%) cases, seizure in 4(5.4%) cases, dysphasia in 2(3%) cases, meningitis in 2(3%) cases, and skin defect with wound infection in 2(3%) cases. No death and CSF leak was recorded. Surgical treatment of depressed skull fracture with prophylactic antibiotics and antiepileptics has good results and few complications.